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December 1989

Use of Sequential B-Mode Ultrasonography to Manage Abdominal Aortic Aneurysms-Reply

Author Affiliations

Maywood, Ill

Arch Surg. 1989;124(12):1464. doi:10.1001/archsurg.1989.01410120114024

In Reply.—Dr Johnson's comments and recommendations are not entirely clear to us. Is he advocating operating on any AAA regardless of size in the low-risk patient? Our data and those of Bernstein and Chan1 strongly support the safety of following up small AAAs to at least 5 cm and perhaps even 6 cm in diameter in the high-risk patient before recommending operation. Only one AAA less than 5.0 cm in diameter ruptured in each series. Of the seven patients who had ruptured AAAs in our series, four either refused repair or were deemed too high risk and never underwent operation. Of the three patients with AAAs that ruptured, two were not operative candidates and were operated on only because the AAA ruptured while in the hospital. You may correctly argue that our operative mortality in elective aneurysm repair of 6.7% is a little high, but three of

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